Provider Demographics
NPI:1912318148
Name:ISACC, ANN MARY (MS,PHARM D,BCPS,CGP)
Entity Type:Individual
Prefix:
First Name:ANN MARY
Middle Name:
Last Name:ISACC
Suffix:
Gender:F
Credentials:MS,PHARM D,BCPS,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 ASPEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3107 MARKET PL
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6756
Practice Address - Country:US
Practice Address - Phone:608-781-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15324-401835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric